Skip to main content
SpringerLink
Log in

Growth recovery lines: a specific indicator of child abuse and neglect?

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Growth recovery lines are radiodense lines in long bones reported to be indicators of stress.

Objective

The purpose of this study was to understand the distribution, quantity and associations of growth recovery lines in children ages 0–24 months with high and low risk for child maltreatment.

Materials and methods

We conducted a retrospective cohort study of children ages 0–24 months who had skeletal surveys and an assessment for maltreatment. Growth recovery lines, fractures and osteopenia were assessed independently by two pediatric radiologists blinded to the abuse likelihood.

Results

Of the 135 children in this study, 58 were in the low-risk group, 26 were in the neglect group, and 51 were in the physical abuse group. Children in the neglected and physically abused groups had 1.73 times (95% confidence interval [CI] of 1.16, 2.59), P=0.007) and 1.84 times (95% CI 1.28, 2.63, P<0.001) more growth recovery lines than the low-risk group, respectively. Growth recovery lines occurred at an earlier age in the neglect group (age interaction P=0.03) and abuse group (age interaction P=0.01) compared to the low-risk group. The specificity for maltreatment in children with at least 10 growth recovery lines in the long bones was greater than 84%, while sensitivity was less than 35%. The most common locations for growth recovery lines were distal radius, proximal tibia and distal tibia.

Conclusion

In the absence of a known major stressor, physical abuse and neglect should be considered in children younger than 24 months with at least 10 growth recovery lines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Geber J (2014) Skeletal manifestations of stress in child victims of the great Irish famine (1845–1852): prevalence of enamel hypoplasia, Harris lines, and growth retardation. Am J Phys Anthropol 155:149–161

    Article  Google Scholar 

  2. Maat GJ (1984) Dating and rating of Harris's lines. Am J Phys Anthropol 63:291–299

    Article  CAS  Google Scholar 

  3. McHenry H (1968) Transverse lines in long bones of prehistoric California Indians. Am J Phys Anthropol 29:1–17

    Article  CAS  Google Scholar 

  4. Acheson RM (1959) Effects of starvation, septicaemia and chronic illness on the growth cartilage plate and metaphysis of the immature rat. J Anat 93:123–130

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Kennedy JW, Irwin GJ, Huntley JS (2014) Growth arrest lines and intra-epiphyseal silhouettes: a case series. BMC Res Notes 7:27

    Article  Google Scholar 

  6. Park EA (1964) The imprinting of nutritional disturbances on the growing bone. Pediatrics 33:815–862

    Google Scholar 

  7. Teele RL, Abbott GD, Mogridge N, Teele DW (1999) Femoral growth lines: bony birthmarks in infants. AJR Am J Roentgenol 173:719–722

    Article  CAS  Google Scholar 

  8. Alfonso-Durruty MP (2011) Experimental assessment of nutrition and bone growth's velocity effects on Harris lines formation. Am J Phys Anthropol 145:169–180

    Article  Google Scholar 

  9. Papageorgopoulou C, Suter SK, Ruhli FJ, Siegmund F (2011) Harris lines revisited: prevalence, comorbidities, and possible etiologies. Am J Hum Biol 23:381–391

    Article  Google Scholar 

  10. Hernandez RJ, Poznanski AK, Hopwood NJ, Kelch RP (1978) Incidence of growth lines in psychosocial dwarfs and idiopathic hypopituitarism. AJR Am J Roentgenol 131(3)

    Article  CAS  Google Scholar 

  11. Zapala MA, Tsai A, Kleinman PK (2016) Growth recovery lines are more common in infants at high vs. low risk for abuse. Pediatr Radiol 46:1275–1281

    Article  Google Scholar 

  12. Garn SM, Silverman FN, Hertzog KP, Rohmann CG (1968) Lines and bands of increased density. Their implication to growth and development. Med Radiogr Photogr 44:58–89

    CAS  PubMed  Google Scholar 

  13. Ogden JA (1984) Growth slowdown and arrest lines. J Pediatr Orthop 4:409–415

    Article  CAS  Google Scholar 

  14. Hughes C, Heylings DJ, Power C (1996) Transverse (Harris) lines in Irish archaeological remains. Am J Phys Anthropol 101:115–131

    Article  CAS  Google Scholar 

  15. American Academy of Pediatrics Section on Radiology (2009) Diagnostic imaging of child abuse. Pediatrics 123:1430–1435

    Article  Google Scholar 

  16. American College of Radiology (2016) ACR–SPR practice parameter for the performance and interpretation of skeletal surveys in children. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Skeletal-Survey.pdf. Accessed 30 March 2018

  17. Scott AB, Hoppa RD (2015) A re-evaluation of the impact of radiographic orientation on the identification and interpretation of Harris lines. Am J Phys Anthropol 156:141–147

    Article  Google Scholar 

  18. Mays S (1995) The relationship between Harris lines and other aspects of skeletal development in adults and juveniles. J Archaeol Sci 22:10

    Google Scholar 

  19. Gelfond J, Goros M, Hernandez B, Bokov A (2018) A system for an accountable data analysis process in R. R J 10:6–21

    Article  Google Scholar 

  20. Klein GL (2015) The effect of glucocorticoids on bone and muscle. Osteoporos Sarcopenia 1:39–45

    Article  Google Scholar 

  21. Grolleau-Raoux JL, Crubezy E, Rouge D et al (1997) Harris lines: a study of age-associated bias in counting and interpretation. Am J Phys Anthropol 103:209–217

    Article  CAS  Google Scholar 

  22. Duffy SO, Squires J, Fromkin JB, Berger RP (2011) Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. Pediatrics 127:e47–e52

    Article  Google Scholar 

  23. Jenny C, Hymel KP, Ritzen A et al (1999) Analysis of missed cases of abusive head trauma. JAMA 281:621–626

    Article  CAS  Google Scholar 

  24. King WK, Kiesel EL, Simon HK (2006) Child abuse fatalities: are we missing opportunities for intervention? Pediatr Emerg Care 22:211–214

    Article  Google Scholar 

  25. Oral R, Yagmur F, Nashelsky M et al (2008) Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse. Pediatr Emerg Care 24:816–821

    Article  Google Scholar 

  26. Ravichandiran N, Schuh S, Bejuk M et al (2010) Delayed identification of pediatric abuse-related fractures. Pediatrics 125:60–66

    Article  Google Scholar 

  27. Jackson G (1972) Child abuse syndrome: the cases we miss. Br Med J 2:756–757

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Qianqian Liu, who performed statistical programming and generated tables and graphics for this manuscript. The authors thank Robert Geller, who programmed the data collection tool in REDCap.

Author information

Authors and Affiliations

  1. Department of Pediatrics / Division of Child Abuse, UT Health Science Center at San Antonio, San Antonio, TX, USA

    Lora R. Spiller & Nancy D. Kellogg

  2. Department of Radiology, Children’s Hospital of San Antonio, San Antonio, TX, USA

    Maria-Gisela Mercado-Deane & Anthony I. Zarka

  3. Department of Epidemiology and Biostatistics, UT Health Science Center at San Antonio, San Antonio, TX, USA

    Jonathan A. L. Gelfond

Authors
  1. Lora R. Spiller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nancy D. Kellogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria-Gisela Mercado-Deane
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anthony I. Zarka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jonathan A. L. Gelfond
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lora R. Spiller.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Spiller, L.R., Kellogg, N.D., Mercado-Deane, MG. et al. Growth recovery lines: a specific indicator of child abuse and neglect?. Pediatr Radiol 50, 207–215 (2020). https://doi.org/10.1007/s00247-019-04526-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-019-04526-x

Keywords

Search

Navigation